[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 459 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 459

 To improve and enhance substance use disorder programs for members of 
               the Armed Forces, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 24, 2009

 Mrs. McCaskill (for herself and Mr. Corker) introduced the following 
   bill; which was read twice and referred to the Committee on Armed 
                                Services

_______________________________________________________________________

                                 A BILL


 
 To improve and enhance substance use disorder programs for members of 
               the Armed Forces, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Supporting Uniformed Personnel by 
Providing Oversight and Relevant Treatment for Substance Use Disorders 
Act'' or the ``SUPPORT for Substance Use Disorders Act''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The Armed Forces is comprised of more than 1,400,000 
        members in the regular components and more than 1,080,000 
        members in the Reserves. More than 1,800,000 members of the 
        Armed Forces have been deployed in Operation Iraqi Freedom, 
        Operation Enduring Freedom, and the Global War on Terrorism 
        since 2001.
            (2) Substance use disorders are chronic diseases that can 
        be prevented, treated, and managed effectively. Failure to 
        prevent or treat these conditions results in severe and 
        widespread consequences, including increased risk of suicide, 
        exacerbation of mental and physical health disorders, increased 
        risk of domestic violence and family discord, and increased 
        risk of unemployment and homelessness.
            (3) According to the 2005 Department of Defense Survey of 
        Health Related Behaviors Among Active Duty Personnel, 24 
        percent of the members of the Armed Forces surveyed reported 
        symptoms of alcohol dependence and nearly 11 percent of the 
        members surveyed reported use of an illicit drug. Misuse of 
        controlled prescription drugs, particularly narcotic 
        painkillers, is a significant and growing problem among members 
        of the Armed Forces as well.
            (4) Substance abuse disorders often co-occur with other 
        health problems. According to the 2007 Report of the Department 
        of Defense Task Force on Mental Health, 17 percent of soldiers 
        from brigade combat teams are at risk of developing clinically 
        significant symptoms of post-traumatic stress disorder (PTSD), 
        major depression, or anxiety after deployment, and an even 
        higher percentage of such soldiers, 28 percent, would 
        experience symptoms based upon broader screening criteria. The 
        prevalence of post-traumatic stress disorder within a year of 
        combat deployment was estimated to range from 10 to 25 percent.
            (5) According to the 2007 Report of the Department of 
        Defense Task Force on Mental Health, symptoms of disorders such 
        as post-traumatic stress disorder often include complex 
        disinhibitory behaviors such as self-medicating with alcohol, 
        other medications, or illicit drugs in an attempt to return to 
        ``normalcy''.
            (6) According to the 2007 Report of the Department of 
        Defense Task Force on Mental Health, of the 686,306 veterans 
        separated from active duty between 2002 and December 2006 who 
        were eligible for care from the Department of Veterans Affairs, 
        229,015 (or 33 percent) accessed care at a Department facility. 
        Of those veterans who accessed such care since 2002, 83,889 (or 
        37 percent) were diagnosed with or were evaluated for a mental 
        disorder, including post-traumatic stress disorder (39,243 or 
        17 percent), nondependent abuse of drugs (33,099 or 14 
        percent), and depressive disorder (27,023 or 12 percent).
            (7) According to the 2007 Report of the Department of 
        Defense Task Force on Mental Health, 20 percent of married 
        soldiers planned to separate or divorce.
            (8) According to the 2007 Report of the Department of 
        Defense Task Force on Mental Health, relationship problems are 
        the top risk factor for suicide. Mental disorders, alcohol and 
        substance use disorders, and significant stress are other 
        significant risk factors for suicide. The National Violent 
        Death Reporting System of the Centers for Disease Control and 
        Prevention determined that, of a group of former or current 
        military personnel who died by suicide in 2005, 17.2 percent 
        had an alcohol problem and 7.7 percent had a problem with other 
        substances. The suicide prevention action network (SPAN) 
        reports a 20 percent increase in suicide among members of the 
        Armed Forces on active duty, 89 suicides in 2007 with 32 deaths 
        under investigation, and a rise of attempted suicides by 
        soldiers by 6 times higher than it was at the start of 
        Operation Iraqi Freedom.
            (9) While some commands and facilities in the Armed Forces 
        provide outstanding services for members of the Armed Forces 
        for substance use disorders, the prevention, diagnosis, 
        mitigation, treatment, and management of, and research on, 
        substance use disorders in members of the Armed Forces is 
        inconsistent in availability, structure, and success among the 
        various Armed Forces.

SEC. 3. COMPREHENSIVE PLAN ON PREVENTION, DIAGNOSIS, MITIGATION, 
              TREATMENT, AND MANAGEMENT OF SUBSTANCE USE DISORDERS IN 
              MEMBERS OF THE ARMED FORCES.

    (a) Review and Assessment of Current Capabilities.--
            (1) In general.--Not later than 180 days after the date of 
        the enactment of this Act, the Secretary of Defense shall, in 
        consultation with the Secretaries of the military departments 
        and the Secretary of Veterans Affairs, conduct a comprehensive 
        review of the programs and activities of the Department of 
        Defense for the prevention, diagnosis, mitigation, treatment, 
        and management of, and research on, substance use disorders in 
        members of the Armed Forces.
            (2) Elements.--The review conducted under paragraph (1) 
        shall include, but not be limited to, an assessment of each of 
        the following:
                    (A) The current state and effectiveness of the 
                programs of the Department of Defense and the military 
                departments relating to the prevention, diagnosis, 
                mitigation, treatment, and management of, and research 
                on, substance use disorders in members of the Armed 
                Forces.
                    (B) The adequacy of the availability of and access 
                to care for substance use disorders in military medical 
                treatment facilities and under the TRICARE program.
                    (C) The adequacy of oversight by the Department of 
                programs relating to the prevention, diagnosis, 
                mitigation, treatment, and management of substance use 
                disorders in members of the Armed Forces.
                    (D) The adequacy and appropriateness of current 
                credentials and other requirements for healthcare 
                professionals treating members of the Armed Forces with 
                substance use disorders, including an assessment of the 
                advisability of adopting uniform credentials and 
                requirements for such treatment for healthcare 
                professionals who are members of organizations such as 
                the Association for Addiction Professionals (NAADAC), 
                the American Society of Addiction Medicine (ASAM), the 
                American Psychiatric Association (APA), and the 
                National Board for Certified Counselors (NBCC).
                    (E) The advisable ratio of physician and non-
                physician care providers for substance use disorders to 
                members of the Armed Forces with such disorders.
                    (F) The adequacy and appropriateness of protocols 
                for the diagnosis, treatment, and management of 
                substance use disorders in members of the Armed Forces.
                    (G) The adequacy of the availability of and access 
                to care for substance use disorders for members of the 
                reserve components of the Armed Forces when compared 
                with the availability of and access to care for 
                substance use disorders for members of the regular 
                components of the Armed Forces, including an 
                identification of any obstacles that are unique to the 
                prevention, diagnosis, mitigation, treatment, and 
                management of substance use disorders in members of the 
                reserve components of the Armed Forces.
                    (H) The adequacy of the prevention, diagnosis, 
                mitigation, treatment, and management of substance use 
                disorders and related distress in dependent family 
                members of members of the Armed Forces, whether such 
                family members suffer from their own substance use 
                disorder or because of the substance use disorder of a 
                member of the Armed Forces.
                    (I) Any gaps in the current capabilities of the 
                Department of Defense for the prevention, diagnosis, 
                mitigation, treatment, and management of, and research 
                on, substance use disorders in members of the Armed 
                Forces.
            (3) Report.--Not later than 180 days after the date of the 
        enactment of this Act, the Secretary of Defense shall submit to 
        the congressional defense committees a report setting forth the 
        findings and recommendations of the Secretary as a result of 
        the review conducted under paragraph (1). The report shall--
                    (A) set forth the findings and recommendations of 
                the Secretary regarding each element of the review set 
                forth in paragraph (2);
                    (B) set forth relevant statistics on the frequency 
                of substance use disorders in members of the regular 
                components of the Armed Forces, members of the reserve 
                component of the Armed Forces, and dependents of such 
                members (including spouses and children); and
                    (C) include such other findings and recommendations 
                on improvements to the current capabilities of the 
                Department of Defense for the prevention, diagnosis, 
                mitigation, treatment, and management of, and research 
                on, substance use disorders in members of the Armed 
                Forces as the Secretary considers appropriate.
    (b) Plan for Improvement and Enhancement of Programs.--
            (1) Plan required.--Not later than 180 days after the date 
        of the enactment of this Act, the Secretary of Defense shall, 
        in consultation with the Secretaries of the military 
        departments and the Secretary of the Department of Veterans 
        Affairs, submit to the congressional defense committees a 
        comprehensive plan for the improvement and enhancement of the 
        programs and activities of the Department of Defense for the 
        prevention, diagnosis, mitigation, treatment, and management 
        of, and research on, substance use disorders in members of the 
        Armed Forces and their dependent family members.
            (2) Basis.--The comprehensive plan required by paragraph 
        (1) shall take into account the following:
                    (A) The results of the review and assessment 
                conducted under subsection (a).
                    (B) Any preliminary results of the study required 
                by section 4.
                    (C) Similar initiatives of the Secretary of 
                Veterans Affairs to expand and improve care for 
                substance use disorders among veterans, including the 
                programs and activities conducted under title I of the 
                Veterans' Mental Health and Other Care Improvements Act 
                of 2008 (Public Law 110-387; 112 Stat. 4112).
            (3) Comprehensive statement of policy.--The comprehensive 
        plan required by paragraph (1) shall include a comprehensive 
        statement of the policy of the Department of Defense regarding 
        the prevention, diagnosis, mitigation, treatment, and 
        management of, and research on, substance use disorders in 
        members of the Armed Forces and their dependent family members.
            (4) Availability of services and treatment.--The 
        comprehensive plan required by paragraph (1) shall include 
        mechanisms to ensure the availability to members of the Armed 
        Forces and their dependent family members of services and 
        treatment for substance use disorders, including, but not 
        limited to, services and treatment as follows:
                    (A) Screening for substance use disorder in all 
                settings, including primary care settings.
                    (B) Short-term motivational counseling services.
                    (C) Marital and family counseling.
                    (D) Inpatient, intensive outpatient, or other 
                residential care services.
                    (E) Private medical, psychiatric, and professional 
                counseling services.
                    (F) Relapse prevention services.
                    (G) Ongoing aftercare and outpatient counseling 
                services.
                    (H) Pharmacological treatments aimed at treating 
                substance use disorders, including treating cravings 
                for drugs and alcohol.
                    (I) Detoxification and stabilization services.
                    (J) Coordination with groups providing peer-to-peer 
                counseling.
                    (K) Such other services as the Secretary considers 
                appropriate.
            (5) Prevention and reduction of disorders.--The 
        comprehensive plan required by paragraph (1) shall include 
        mechanisms to facilitate the prevention and reduction of 
        substance use disorders in members of the Armed Forces through 
        science-based initiatives, including education programs, for 
        members of the Armed Forces and their families.
            (6) Specific instructions.--The comprehensive plan required 
        by paragraph (1) shall include each of the following
                    (A) Substances of abuse.--Instructions on the 
                prevention, diagnosis, mitigation, treatment, and 
                management of substance use disorders in members of the 
                Armed Forces, including the abuse of alcohol, illicit 
                drugs, and nonmedical use and abuse of prescription 
                drugs (including addiction to prescription drugs that 
                is an unintended consequence of otherwise required and 
                medically appropriate pain treatment).
                    (B) Healthcare professionals.--Instructions on--
                            (i) appropriate training of healthcare 
                        professionals in the prevention, screening, 
                        diagnosis, mitigation, treatment, and 
                        management of substance use disorders in 
                        members of the Armed Forces;
                            (ii) appropriate staffing levels for 
                        healthcare professionals at military medical 
                        treatment facilities for the prevention, 
                        screening, diagnosis, mitigation, treatment, 
                        and management of substance use disorders in 
                        members of the Armed Forces; and
                            (iii) such uniform training and 
                        credentialing requirements for physician and 
                        non-physician healthcare professionals in the 
                        prevention, screening, diagnosis, mitigation, 
                        treatment, and management of substance use 
                        disorders in members of the Armed Forces as the 
                        Secretary considers appropriate.
                    (C) Services for dependents.--Instructions on the 
                availability of services for substance use disorders to 
                military dependents (including services for dependents 
                suffering from their own substance use disorder and 
                dependents suffering because of the substance use 
                disorder of a member of the Armed Forces), including 
                instructions on making such services available to such 
                dependents to the maximum extent practicable.
                    (D) Prevention materials.--Instructions on the 
                dissemination of materials regarding substance abuse 
                prevention, including, at a minimum, materials on the 
                following:
                            (i) The dangers of alcohol abuse.
                            (ii) The risks of self-medication, and the 
                        potential co-occurrence of drug use or abuse 
                        with illnesses such as Post Traumatic Stress 
                        Disorder (PTSD).
                            (iii) The risks associated with abuse of 
                        prescription medications and the signs of 
                        inadvertent addiction to prescription 
                        medications that may occur as a consequence of 
                        otherwise prescribed treatment plans, as well 
                        as the need to properly secure and dispose of 
                        such substances to safeguard such substances 
                        from third parties such as children.
                            (iv) The risks of substance abuse faced by 
                        military dependents due to the stresses of 
                        having a spouse or parent deployed, as well as 
                        other factors relating to substance abuse that 
                        are unique to military families.
                            (v) Strategies for prevention of drug and 
                        alcohol abuse among children of military 
                        families, and suggestions for military parents 
                        on how to intervene and find help for a child 
                        with a substance use disorder.
                    (E) Differentiation of disciplinary action and 
                treatment.--Instructions on the separation of 
                disciplinary actions from prevention and treatment of 
                substance use disorders in members of the Armed Forces.
                    (F) Confidentiality.--Instructions on 
                confidentiality for members of the Armed Forces in 
                seeking or receiving services or treatment for 
                substance use disorders.
                    (G) Participation of chain of command.--
                Instructions on appropriate consultation, reference to, 
                and involvement of the chain of command of members of 
                the Armed Forces in matters relating to the diagnosis, 
                treatment, and management substance use disorders in 
                such members.
                    (H) Consideration of gender.--Instructions on 
                gender specific requirements in the prevention, 
                diagnosis, mitigation, treatment, and management of 
                substance use disorders in members of the Armed Forces, 
                including gender specific care and treatment 
                requirements.
                    (I) Coordination with other healthcare 
                initiatives.--Instructions on the integration of 
                efforts on the prevention, diagnosis, mitigation, 
                treatment, and management of substance use disorders in 
                members of the Armed Forces with efforts to address co-
                occurring health care disorders (such as post-traumatic 
                stress disorder (PTSD) and depression) and suicide 
                prevention.
            (7) Other elements.--In addition to the matters specified 
        in paragraph (3), the comprehensive plan required by paragraph 
        (1) shall include the following:
                    (A) Lead agent.--The designation by the Assistant 
                Secretary of Defense for Health Affairs of a lead agent 
                to coordinate implementation of the plan.
                    (B) Milestones and schedules.--Milestones and 
                schedules for the achievement of the goals of the plan, 
                including goals relating to the following:
                            (i) Enhanced education of members of the 
                        Armed Forces regarding substance use disorders.
                            (ii) Enhanced and improved identification 
                        and diagnosis of substance use disorders in 
                        members of the Armed Forces.
                            (iii) Enhanced and improved access of 
                        members of the Armed Forces to services and 
                        treatment for and management of substance use 
                        disorders.
                            (iv) Appropriate staffing of military 
                        medical treatment facilities and other 
                        facilities for the treatment of substance use 
                        disorders in members of the Armed Forces.
                    (C) Best practices.--The incorporation of evidence-
                based best practices utilized in current military and 
                civilian approaches to the prevention, diagnosis, 
                mitigation, treatment, and management of substance use 
                disorders.
                    (D) Available research.--The incorporation of 
                applicable results of available studies, research, and 
                academic reviews on the prevention, diagnosis, 
                mitigation, treatment, and management of substance use 
                disorders.
            (8) Update in light of independent study.--Upon the 
        completion of the study required by section 4, the Secretary of 
        Defense shall--
                    (A) in consultation with the Secretaries of the 
                military departments and the Secretary of the 
                Department of Veterans Affairs, make such modifications 
                and improvements to the comprehensive plan required by 
                paragraph (1) as the Secretary of Defense considers 
                appropriate in light of the findings and 
                recommendations of the study; and
                    (B) submit to the congressional defense committees 
                a report setting forth the comprehensive plan as 
                modified and improved under subparagraph (A).

SEC. 4. INDEPENDENT REPORT ON SUBSTANCE USE DISORDERS IN MEMBERS OF THE 
              ARMED FORCES.

    (a) Study Required.--The Secretary of Defense shall provide for a 
study on substance use disorders in members of the Armed Forces to be 
conducted by the Institute of Medicine of the National Academies of 
Sciences or such other independent entity as the Secretary shall select 
for purposes of the study.
    (b) Elements.--The study required by subsection (a) shall include a 
review and assessment of the following:
            (1) The current state and effectiveness of the programs of 
        the Department of Defense and the military departments relating 
        to the prevention, diagnosis, mitigation, treatment, and 
        management of, and research on, substance use disorders in 
        members of the Armed Forces.
            (2) The adequacy of the availability of and access to care 
        for substance use disorders in military medical treatment 
        facilities and under the TRICARE program.
            (3) The adequacy of the oversight by the Department of 
        Defense of programs related to the prevention, diagnosis, 
        mitigation, treatment, and management of substance use 
        disorders in members of the Armed Forces.
            (4) The adequacy and appropriateness of current credentials 
        and other requirements for physician and non-physician 
        healthcare professionals treating members of the Armed Forces 
        with substance use disorders.
            (5) The advisable ratio of physician and non-physician care 
        providers for substance use disorders to members of the Armed 
        Forces with such disorders.
            (6) The adequacy and appropriateness of protocols for the 
        diagnosis, treatment, and management of substance use disorders 
        in members of the Armed Forces.
            (7) The adequacy of the availability of and access to care 
        for substance use disorders for members of the reserve 
        components of the Armed Forces when compared with the 
        availability of and access to care for substance use disorders 
        for members of the regular components of the Armed Forces.
            (8) The adequacy of the prevention, diagnosis, mitigation, 
        treatment, and management of substance use disorders in 
        dependent family members of members of the Armed Forces, 
        whether such family members suffer from their own substance use 
        disorder or because of the substance use disorder of a member 
        of the Armed Forces.
            (9) The need for and appropriate provision of 
        confidentiality for members of the Armed Forces who seek 
        services or treatment for a substance use disorder.
            (10) Such other matters as the Secretary considers 
        appropriate for purposes of the study.
    (c) Report.--Not later than one year after the date of the 
enactment of this Act, the entity conducting the study required by 
subsection (a) shall submit to the Secretary of Defense and the 
congressional defense committees a report on the results of the study. 
The report shall set forth the findings and recommendations of the 
entity as a result of the study.

SEC. 5. CENTER OF EXCELLENCE IN THE PREVENTION, DIAGNOSIS, MITIGATION, 
              TREATMENT, AND MANAGEMENT OF SUBSTANCE USE DISORDERS.

    (a) In General.--The Secretary of Defense shall establish within 
the Department of Defense a Center of Excellence in the Prevention, 
Diagnosis, Mitigation, Treatment, and Management of Substance Use 
Disorders.
    (b) Partnerships.--The Secretary of Defense shall ensure that the 
Center collaborates to the maximum extent practicable with the 
Department of Veterans Affairs, institutions of higher education, and 
other appropriate public and private entities (including international 
entities) to carry out the responsibilities specified in subsection 
(c).
    (c) Responsibilities.--The Center shall have responsibilities as 
follows:
            (1) To implement the comprehensive plan of the Department 
        of Defense for the prevention, diagnosis, mitigation, 
        treatment, and management of substance use disorders under 
        section 3, including the performance of research on gender and 
        ethnic group-specific health needs related to substance use 
        disorders.
            (2) To provide for the development, testing, and 
        dissemination within the Department of evidence-based best 
        practices for the prevention, diagnosis, mitigation, treatment, 
        and management of substance use disorders.
            (3) To provide guidance for healthcare professionals and 
        support service staff of the health system of the Department in 
        providing quality health care for members of the Armed Forces 
        with substance use disorders, and their dependents, when 
        possible, who are suffering from the effects of substance use 
        disorders.
            (4) To provide guidance for healthcare professionals and 
        support service staff to make members of the Armed Forces 
        receiving prescription pain medications aware of the potential 
        for abuse of or addiction to such substances, and to provide 
        such members education on ways of properly securing such 
        substances and disposing of such substances when no longer 
        needed.
            (5) To recommend uniform credentials and other requirements 
        for healthcare professionals and support service staff who 
        provide care and support for members of the Armed Forces and 
        their dependents who suffer from substance use disorders.
            (6) To establish, implement, and oversee a uniform and 
        comprehensive program to train physician and non-physician 
        healthcare professionals and support staff in the Department in 
        the screening, intervention, treatment, and management of 
        substance use disorders.
            (7) To coordinate research, data collection, and data 
        dissemination on the prevention, diagnosis, mitigation, 
        treatment, and management of substance use disorders, and to 
        maintain a database of information for that purpose.
            (8) To facilitate advancements in the study of the short-
        term and long-term physical and psychological effects of 
        substance use disorders.
            (9) To disseminate evidence-based best practices within the 
        military medical treatment facilities for training healthcare 
        professionals and support staff with respect to substance use 
        disorders.
            (10) To conduct basic science and translational research on 
        substance use disorders in members of the Armed Forces for the 
        purposes of understanding the etiology of substance use 
        disorders and developing preventive interventions and new 
        treatments.
            (11) To develop programs and outreach strategies for 
        families of members of the Armed Forces with substance use 
        disorders to address and to mitigate the impact of substance 
        use disorders on such family members and to support the 
        recovery of such members from substance use disorders.
            (12) To conduct research on the health needs of families of 
        members of the Armed Forces with substance use disorders and 
        develop protocols to address any needs identified through such 
        research.
            (13) To disseminate information to families of members of 
        the Armed Forces regarding ways to help prevent alcohol and 
        drug abuse among their children, as well as educational 
        materials to address how situations unique to military 
        families, such as having a parent deployed, can increase stress 
        levels and put a child at increased risk of abusing drugs or 
        alcohol.
            (14) To develop and oversee a long-term plan to increase 
        the number of healthcare professionals and support personnel 
        within the Department in order to facilitate the meeting by the 
        Department of the needs of members of the Armed Forces with 
        substance use disorders while they remain on active duty and 
        until their transition to care and treatment from the 
        Department of Veterans Affairs.
            (15) To develop and deploy an education and awareness 
        training initiative designed to reduce the negative stigma 
        associated with substance use disorders and treatment.
            (16) Such other responsibilities as the Secretary shall 
        specify.

SEC. 6. CONGRESSIONAL DEFENSE COMMITTEES DEFINED.

    In this Act, the term ``congressional defense committees'' means--
            (1) the Committee on Armed Services and the Committee on 
        Appropriations of the Senate; and
            (2) the Committee on Armed Services and the Committee on 
        Appropriations of the House of Representatives.
                                 <all>